Dementia Care & Research Analysis

This assignment involves a comprehensive review of selected academic papers, reports, and statistics on the topic of dementia. The primary goal is to analyze and synthesize information from these sources, focusing on various aspects including behavioral and psychological symptoms, preventive measures like statin usage, barriers to palliative care, and the health impact on caregivers. Additionally, it requires evaluating research methods and findings, with particular attention paid to the meta-analysis of randomized controlled trials.

CHALLENGES
OF
AGEING SPRING
2017

Table of Contents
INTRODUCTION...........................................................................................................................1
Three issues that hinder the provision of palliative care for older people having end stage
dementia...........................................................................................................................................1
Critical analyse on one of the issues identified................................................................................3
Recommendation ............................................................................................................................6
Conclusion ......................................................................................................................................6
REFERENCES................................................................................................................................8

INTRODUCTION
Every Australian expects to die with some nobility and should have control over the
conditions like to be present with choice of people they want and at the place of their wish at the
end moment of life. This particular report includes the discussion on three major issues that
create obstruction in providing palliative care to the patients suffering from end stage dementia
that are: lack of resources, lack of communications and lack of training. Further it emphasizes
more on given issue of lack in communication and recommendations are provided on the basis of
learning to improve the personal and overall working standards.
Three issues that hinder the provision of palliative care for older people
having end stage dementia
Dementia is failure of brain from working, although it a slow process. Palliative care is a
special type of care given to patients of dementia with the goal to improve the standards of life
for both patient and their family. This care is a different type of approach from the other present
medical care strategy. It is a type of perspective that aims in improving the patients' life quality
along with their families that are facing problems related to the life threatening disease. It
includes the providing relief to the sufferer by identifying the disease at earlier stages and
accordingly providing them with treatment to get relief from pain, also the other physical and
psychological problems. More that 413,106 people in Australia are living with dementia out of
which 55% (228,238) are females and 45% (184,868) are males. By the coming 2025 the rate of
people with dementia is expected to increase up to 536,164 (Australian statistics, 2017).
There are several residential heath care facilities in Australia that provide palliative care
to the people dealing with end stage dementia. But there are certain issues that hamper the
delivery of family focused palliative care to the older people that are living the life with end
stage dementia in residential aged care facilities. The three major issues are: Lack of resources in
residential aged care facilities, lack of training of health workers and lack of communication.
Resources plays a major role in proper working of any concerned organisation. Similarly
the resources are requires in residential aged care facilities in Australia to keep up with all the
requirements for patients safety and proper treatment. But these care facilities are facing problem
related to the lack of resource which includes the deficiency in funding, insufficiency of time and
shortage of working staff. Such problem poses the barrier in providing proper services to the
patients. Deficiency in funds will lead to shortages in proper medicines and required
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technologies to treat acute problems of dementia that directly had its impact on the health of
patients (Carter, Levetown & Friebert 2013). Insufficiency of time also plays a major role in
treatment, specially in the critical conditions that may also obstruct the involvement of family or
patients in decision making and causes damage to whole care process. Lack of time is the major
barrier in providing the productive care to the old people with dementia and this start creating
depression which worsen the situation of the patients who are in last stage of this serous disease.
Adequate working staff in care centres is of keen requirement to come up with the needs of
patients. According to the experience, the workers in care centres are assigned with their duties.
There is necessity of senior consultant who see the patients at certain time to keep a watch on
their progress over disease along with the assistant staff for daily administering of treatment and
health requirement of the patients (Miller & Boeve, 2016).
Second major issue that hinders provision of palliative care to older people with dementia
is the lack of training and the education to the both new and the existing working staff. Existing
working staff needs training to skill up the technique and working standards. It is very important
for the new joined working staff to get through a basic or a primary level training for the
particular specialization. This training mainly includes the understanding the concepts of
applying the palliative care approach to the patients and to enhance the ability of recognising the
sign of forthcoming death. Dementia is the irreversible syndrome which is identified by the loss
of mental function that primarily includes the loss of memory, change in the personality,
problems in doing the daily life activities and disorientation (Groot & et.al. 2016, pp.13-23). This
disease is incurable and a number of patients die every year in Australia (Langa 2015, p.34).
This disease many effects the older people which requires the need of palliative care or end to
life care. Lack of such training is a threat to the patients itself, as the worker lack the proper
knowledge and skills sets that are required to treat the patients with end stage dementia. The last
stage of this disease causes the complete decline in the working of brain (Kasper 2015, pp.217-
228). At this stage the patients are more vulnerable to many other infections and pneumonia, so
nurses and care worker require training preventing such infections from happening (Mitchell
2015, pp.2533-2540). This includes the strategies and technique to provide exercise to patients
and manage to read the sign of pains. As person at this stage is unable to speak or interpret about
what they are facing, training is given to read the symptoms through their body language and
expression (van der Steen & et.al. 2014, pp.197-209). Without training no one can understand
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what is happening to the patients. The training includes, treating the patients with proper
understanding and respect by putting emphasize on improving the quality of life. Focus on the
things that particular person enjoy by getting some help from family and friends (Martín & et.al.
2013, pp.48-55). Lack of such training is surely a complete threat for patients. We are aware at
this stage the patient memory is completely lost and are not able to express their need. If a person
is not trained he will not be able understand whether the patient is starving of food or he needs
water to drink. In some cases nurse are even not able to recognise either they are in pain or not,
when the patients start screaming then they come to know that they are in pain. Such practices
will completely effects the life of patients and will worsen the condition they are already in .
Third major issue that hinders provision of palliative care to older people with dementia
is the lack of communication. Lack in communication and collaboration with members of the
family and between the working staff is a major barrier in palliative care for dementia patients.
Proper communication with family or patients plays a major role in providing high quality end-
of-life care to the last stage dementia patients (Reus & et.al. 2016, pp.543-546). To obtain the
high quality care, the working staff and nurses should have highly skilled and effective
communication and collaboration strength with patients , family and other working staff.
According to the discussion in the literature there was a mixed opinion whether to make patients
aware about the particular disease and diagnosis or not (Li & Lewis 2013, pp.924-929 ). Some
were in favour that it should be communicated with patients so that the patient will also take part
in the decision making before any diagnosis take place, while some were in against that directly
communicating with patient will lead him to depression. Here the major concern come up is to
have communication with the concerned family members. Lack of communication with family
member may also lead to the misinterpretation of the nature of disease. Communication problem
among staff also lead to poor team formation and may result in the conflicts between the staff
members that ultimately lead to ill-suited hospitalization (McGuinness & et.al., 2016)
Critical analyse on one of the issues identified
One of the major issue that hinders provision of palliative care to older people with
dementia is the lack of communication. Communication is one of the important key aspect in
providing the patients with best end-to-life services. Lack of communication is not only between
the service providers and patients or family members but it also exists in between the working
staff and nurses. The lack of communication between the registered nurse and patients/family
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includes the proper low of information regarding the diseases and its level of concern. According
to Meira Erel, Esther-Lee Marcus & Freda Dekeyser-Ganz (2017, p.365-379), the
communication between the patients and the working staff or registered nurse must be
prohibited. This is because after knowing the type disease and its consequences patients may
start taking stress regarding his health and the cure of the disease. This will ultimately increase
the level of anxiety in the patients and the final result of is depression. Patient become the prey
of depression that will make there condition worst. But on the other hand according to Nathan
Davies & et.al. (2014, p.386–394 ), a fair communication is must between the patient and the
service provider. Patients have the right to know about what is happening to them and from what
kind of disease they are suffering. They should also get the opportunity to take decision of their
life in case of any diagnosis and treatment as they are only the one who is bearing all the
suffering. This communication will make them aware about the problem they are dealing with
make them much more conscious about themselves.
There were also mixed opinion regarding communication about patients condition among
the family members. According to Tsuruoka & et.al. (2013, pp.2865-2872), the flow of
information regarding the patients condition specially those are in last stage of dementia among
the family is important aspect. As during the last stage of dementia the patients brain completely
stops working and is not able to recognise anything, even they are not able to say anything
regarding the pain they are having even not about the food or other thing they want (Lee & et.al.
2016, pp.117-22). So the involvement of family in this condition is must as they are only one
who can understand the patients more accurately. They can clearly recognize whether they are in
pain or they need something by understanding their facial expression and body language. Also
the family education regarding the particular disease and its effects is necessary because they are
only one who can take further decision of treatment regarding the patients in such type of case
(Hallberg & et.al. 2016, pp.931-957.
Lack of communication among the healthcare providers also act as barrier in providing
palliative care to older people with last stage dementia. Due to the lack of sufficient word
between the working staff and registered nurse may leads to the formation of conflicts among
them. Such conflicts may be between the working staff or between the working staff and higher
professionals. There are various bad outcomes of such communication gaps like disagreement on
various aspect in the working area, formation of poor working team and finally leads to increase
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in stress. According to Richardson & et.al. (2013, p.367), the communication gap among
working staff is mainly due to the lack of training. There are some nurses in the residential aged
care centres who are not trained regarding the concept of palliative care approach for the end-
stage dementia thus it creates the difference of thought between the trained worker and untrained
nurses. Due to the lack of training they are not aware about the techniques and knowledge how to
deal with the patients of this chronic disease. As a result they use wrong methods to deal with
patient that make their condition more pathetic. But according to Dobson-Stone & et.al. (2013,
p.e 56899), main reason behind the nurses not being trained is lack of communication between
the working staff and the higher officials. Due to the communication gap between them they are
not able to figure out the problems and thus it creates more mess. A flow of communication
should be maintained between the small level of workers to the higher official, as it will help
them to identify the weakness or are in which the nurses have to improve themselves. Through
this they come to an outcome that what sort of training can improve there working criteria.
As per the views of Chen & et.al. (2015, pp.20-25), flow of information between higher
authorities and working team is necessary along with the communication among the different
discipline of working staff member. There are certain information regarding the patients like
there need of medicines, grade of dementia disease he is suffering from is necessary to be
communicated with the workers and registered nurses of healthcare and safety discipline. With
this information the nurse of that particular discipline will communicate with healthcare officials
and proper treatment plan can be decided to solve the particular problem. There is need of
maintaining the positive environment in the residential aged care facilities to facilitate the proper
working. It can be only achieved by proper communication among all the working officials and
nurses those are working there. Each patient of dementia need all type care as at the end stage
sufferer memory is completely lost so he is not able to recognise and express anything. Every
thing from food to bathing, estimation of pain sufferer having, is to be recognised by the
different disciplinary working officials and nurses only. The absence of flow of such type of
information will finally had its threatening effect to the patients who is already at the end stage
of chronic disease. With proper education and emphasize on team work spirit will overcome the
communication problems and motivate the staff to work together that will result in more efficient
outcomes (Ennis Jr & Kazer 2013, pp.106-113). Hence flow of communication is the major
thing of concern in case of dementia patients.
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Recommendation
From the above learning regarding the issues of lack in communication between working
officials and staff also among the workers of different discipline, registered nurses (RN) can be
recommended to emphasize more on team work spirit. By applying this concept among the
officials and workers will remove this barrier and increase the working interdependencies of staff
and they will communicate with other officials for every work needed to be done. This will also
improve the problem related to lack of training as communication will help them to identify their
weakness and training can be provided on that basis to improve that particular area of concern
(Tsai & Boxer 2016, pp.211-221.).
The communication between patients and healthcare staff should be promoted but in a
significant manner. In the end stage of dementia the working tendency of brain gets completely
diminished, so family should be involved in conversation and should be acknowledged with the
condition of patient. This step will help in creating more trust of patient and his family on the
working of residential aged care centres.
Other than issue of communication more emphasize on training is must because untrained
nurses and worker can lead to threats to patients (Mast & et.al. 2016, pp.175-182). This also
create the difference of thoughts as the untrained can work according to the knowledge they have
and trained ones will work on the basis of their training they have received. After the recruitment
of new staff first and the foremost work is to train up them with the strategies that help the nurses
and worker to take care of the dementia patients with palliative care approach.
Resources also play the important role in palliative care approach. RN should focus more
on time management and service delivery. As most important resource after the staff is time, if
appropriate time is not given to the particular patients they start developing depression in
themselves. At the end stage dementia the patient is not able to express what they problem they
are facing particularly pain. In lack of appropriate attention to such patients may also lead to
early death (Matsunaga Kishi & Iwata 2016, pp.635-643). RN should also encourage other
working nurses to follow this principle. The ultimate result of all such steps will increase the
quality of remaining life of such critical patients.
Conclusion
From the above report it can be concluded that concept of implementing palliative care
technique in case of end stage dementia is a remarkable approach. Further three issues has been
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discussed that create barrier in proving palliative care for dementia patients that are : lack of
resource, this issue can be solved by providing the care facilities with proper funds and active
working staff . Following the second issue is lack of training and last is lack of communication.
These issue are some what interdependent, issue related to training can be resolved by proper
communication with higher officials, so that they can recognise their field of improvement and
provide them with proper training.
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REFERENCES
Books and journals
Carter, B. S., Levetown, M. & Friebert, S. E. eds., 2013. Palliative care for infants, children,
and adolescents: a practical handbook. JHU Press.
Chen, H. M. & et.al ., 2015. Effectiveness of coping strategies intervention on caregiver burden
among caregivers of elAustralian statistics. 2017derly patients with
dementia. Psychogeriatrics,. 15(1). pp.20-25.
Dobson-Stone, C. & et.al., 2013. C9ORF72 repeat expansion in Australian and Spanish
frontotemporal dementia patients. PloS one,. 8(2). p.e 56899.
Ennis Jr, E. M. & Kazer, M. W., 2013. The role of spiritual nursing interventions on improved
outcomes in older adults with dementia. Holistic nursing practice,. 27(2). pp.106-113.
Groot, C. & et.al., 2016. The effect of physical activity on cognitive function in patients with
dementia: a meta-analysis of randomized control trials. Ageing research reviews,. 25.
pp.13-23.
Hallberg, I. R. & et.al., 2016. Professional care providers in dementia care in eight European
countries; their training and involvement in early dementia stage and in home
care. Dementia,. 15(5). pp.931-957.
Kasper, S., 2015. Phytopharmaceutical treatment of anxiety, depression, and dementia in the
elderly: evidence from randomized, controlled clinical trials. Wiener Medizinische
Wochenschrift,. 165(11-12). pp.217-228.
Langa, K. M., 2015. Is the risk of Alzheimer’s disease and dementia declining?. Alzheimer's
research & therapy,. 7(1). p.34.
Lee, C. W. & et.al., 2016. Antidepressant treatment and risk of dementia: a population-based,
retrospective case-control study. The Journal of clinical psychiatry,. 77(1). pp.117-22.
Li, C. Y. & Lewis, F. M., 2013. Expressed emotion and depression in caregivers of older adults
with dementia: results from Taiwan. Aging & mental health,. 17(8). pp.924-929.
Martín, F. & et.al., 2013. Robots in therapy for dementia patients. Journal of Physical
Agents,. 7(1). pp.48-55.
Mast, G. & et.al., 2016. Persistence of antipsychotic treatment in elderly dementia patients: a
retrospective, population-based cohort study. Drugs-real world outcomes,. 3(2).
pp.175-182.
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Matsunaga, S., Kishi, T. & Iwata, N., 2016. Yokukansan in the treatment of behavioral and
psychological symptoms of dementia: An updated meta-analysis of randomized
controlled trials. Journal of Alzheimer's Disease,. 54(2). pp.635-643.
McGuinness, B. & et.al., 2016. Statins for the prevention of dementia. The Cochrane Library.
Meira Erel, Esther-Lee Marcus & Freda Dekeyser-Ganz, 2017. Barriers to palliative care for
advanced dementia: a scoping review. Annals of Palliative Medicines, .6(4). 365-379
Miller, B. L. & Boeve, B. F. eds., 2016. The behavioral neurology of dementia. Cambridge
University Press.
Mitchell, S. L., 2015. Advanced dementia. New England Journal of Medicine,. 372(26).
pp.2533-2540.
Nathan Davies & et.al., 2014. Barriers to the provision of high-quality palliative care for people
with dementia in England: a qualitative study of professionals experiences. Health and
Social Care in the community, .22(4). 386–394.
Reus, V. I. & et.al., 2016. The American Psychiatric Association practice guideline on the use of
antipsychotics to treat agitation or psychosis in patients with dementia. American
Journal of Psychiatry,. 173(5). pp.543-546.
Richardson, T. J. & et.al., 2013. Caregiver health: health of caregivers of Alzheimer’s and other
dementia patients. Current psychiatry reports,. 15(7). p.367.
Tsai, R.M. & Boxer, A.L., 2016. Therapy and clinical trials in frontotemporal dementia: past,
present, and future. Journal of neurochemistry,. 138(S1). pp.211-221.
Tsuruoka, M. & et.al., 2013. Capillary electrophoresis‐mass spectrometry‐based metabolome
analysis of serum and saliva from neurodegenerative dementia
patients. Electrophoresis,. 34(19). pp.2865-2872.
van der Steen, J. T. & et.al., 2014. White paper defining optimal palliative care in older people
with dementia: a Delphi study and recommendations from the European Association
for Palliative Care. Palliative medicine,. 28(3). pp.197-209.
Online
Australian statistics. 2017. [Online]. Available through
<https://www.fightdementia.org.au/statistics>. [Accessed on 28th August 2017].
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